Provider Demographics
NPI:1780984484
Name:EDWARDS-FRYE, LOUELLA M (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LOUELLA
Middle Name:M
Last Name:EDWARDS-FRYE
Suffix:
Gender:F
Credentials:APRN, FNP-C
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Mailing Address - Street 1:807 STONEWALL RD
Mailing Address - Street 2:
Mailing Address - City:BYHALIA
Mailing Address - State:MS
Mailing Address - Zip Code:38611-9288
Mailing Address - Country:US
Mailing Address - Phone:901-461-0214
Mailing Address - Fax:662-838-9337
Practice Address - Street 1:8541 HIGHWAY 178 STE C
Practice Address - Street 2:
Practice Address - City:BYHALIA
Practice Address - State:MS
Practice Address - Zip Code:38611-9670
Practice Address - Country:US
Practice Address - Phone:662-850-3002
Practice Address - Fax:877-583-5013
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2024-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS904052261QP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS904052OtherADVANCE PRACTICE